Health

Missouri tried to remedy the shortage of doctors. Now the fix might need a fix.

Missouri Rep. Tricia Durges is pushing a bill that would give physician assistants like her the opportunity to become fully licensed doctors in the state.

Not that Derges — one of the most established holders of the Physician Assistant License, created in 2014 to reduce the shortage of doctors — is now the most persuasive advocate.

Last year, Derges was charged with accusations accusing her sales of counterfeit stem cell therapies, illegal prescribing of drugs and obtaining fraudulently covid relief funds. Derges, who did not respond to multiple messages sent to her and her lawyer, pleaded not guilty. But she already was kicked out of Republican Assembly forced to move its legislative office to Broom closet in state houseput on three year probationary period for her drug license and banned from running for re-election as a republican after she was charged. The trial is set for June.

Her personal adversity has jeopardized an already contentious decision for states grappling with gaps in primary health care. Even some early proponents now want to curb the physician assistant license.

Physician assistants, sometimes referred to as junior physicians and not to be confused with physician assistants, are medical graduates who have not yet completed residency training. Similar licenses now exist in Arizona, Arkansas, Kansas, and Utah. Virginia reviews adding one, and the Model Legislation makes it easier than ever for other state legislatures to pass such licenses.

Derges proposed legislation will allow physician assistants to obtain a license—similar to residency doctors—provided the physician assistant has practiced for five years with a collaborating physician, passed the licensing exam, and met certain training requirements.

Her bill will create a new path for physician education. Competing legislation however, it is seeking to reduce the license and limit the number of years Physician Assistants can practice until they return to residency programs.

Dr. Keith Fredericka former state representative and orthopedic surgeon from Rolla, Missouri, proposed the original Physician Assistant Act, the first of its kind in the nation.

Nearly every county in Missouri is short of primary health care providers, according to the federal government. Health Services and Resource Administration. It will take almost 500 doctors to fill that void, but attempts to get doctors to practice in underserved areas have been “chronically unsuccessful,” Frederick said. At the same time, thousands of medical graduates who annually apply for residency are not accepted – 9,155 applicants did not fit the program. only in 2021or about 1 in 5 candidates, most of whom are graduates of international medical schools.

The Physician Assistant License allows medical school graduates to practice medicine in Missouri under a co-practice agreement with a physician who is ultimately responsible for the care provided, and on the condition that they do so in an underserved area. They can examine patients, prescribe medicines, and administer certain treatments in much the same way as nurse practitioners or physician assistants—so-called mid-level practitioners—both of whom are highly trained at the master’s level.

Frederick’s bill passed the same year it was introduced, a legislative feat he called “quite remarkable”.

At the time, this idea had opponents. Chief among these was the Missouri Nurses Association, which claimed that 12,000 nurse practitioners were better equipped to deal with the lack of primary health care. The association is reviewing the state’s rules for practicing nurses. as among “the most restrictive regime in the country.”

At the national level, the American Medical Association, the American Academy of Family Physicians, and the Council for the Accreditation of Graduate Medical Education also objected to the license.

One of the first supporters of this idea was D. Jeff Davischief physician of the Scottish District Hospital in rural Memphis, Missouri and member of the executive committee Missouri Association of Osteopathic Physicians and Surgeons. However, eight years after the law was passed, Davis has no physician assistants working with him, though he said he has several positions that could benefit them.

The problem, according to Davis, is that Medicare will not reimburse medical assistants. Hospitals in the countryside often depend on income from this state insurance program for Americans 65 and older. But for hospitals to be paid by Medicare for the work of a physician assistant, Davis said, the physician assistant must work under the direct supervision of a physician whose name will be used to file the bill.

“It doesn’t make much business sense,” Davis said.

Frederick hopes that the introduction of the Physician Assistant license in more states will force the Medicare and Medicaid Services Centers to start reimbursing the work done by these physicians. The American Exchange Legislative Council adopted model legislation on associate physician after Frederick pitched the idea at a conservative non-profit summit last year.

There are currently 348 paramedic licenses in Missouri, including Dr. Trevor Cook, creator of Physicians Paramedics Association. Cook graduated from the Medical School of American International University in the Caribbean island of Saint Lucia in 2014.

“Unfortunately, I was one of those many, many, many, many thousands of doctors who don’t get into residency every year,” Cook said.

Cook has been practicing at the St. Louis Emergency Center since 2018, a position he described as rewarding. He supports a pathway for full license for medical assistants in Missouri, similar to that proposed by Durges. Regarding the accusation, Cook said that one person’s actions are not representative of the entire group of practitioners.

A review of the state’s current Physician Assistant licenses, including the Derges license, found no disciplinary action in place. Two were previously on probation due to previous behavior.

However, the state’s physician groups that originally supported the idea now want to limit the number of years someone can be licensed as a physician assistant, as other states have done. Under current Missouri law, physician assistants may practice indefinitely.

“Like with everything, you will find people trying to cheat the system, work from an angle, and get something you didn’t plan out of what you did in good faith,” Davis said.

Dr. Sterling Ransonpresident of the American Academy of Family Physicians, said he already had concerns about the quality of care provided by physician assistants, citing a 2018 JAMA article that said they lagging test scores compared to their counterparts in residency programs. He said he had doubts about creating an alternative path to fully license physicians.

“I personally would have problems supporting it without more information to check the quality standards,” Ransone said.

The American Medical Association supports bill in Congress this will increase the number of US residency vacancies by 14,000 over the next seven years.

Dr. Kevin Clowerthe CEO of the American Osteopathic Association, did not close the door on the Physician Assistant role, but said he was skeptical: “We must be held accountable to make sure we put in place all safety measures with training, validation and monitoring. that the medical care provided by the doctor is up to the standard it should be.”

Frederick called these concerns “pure defense of the territory” amid what he says is a huge medical shortage.

“We have all these people who are well trained,” Frederick said. “Why would you waste this resource?”


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